Scribd Logo
Upload

Welcome to Scribd!

  • 160 views

    L-19 Skeletal Muscle Relaxant

    Uploaded by

    Zakiyahulfahdw
    The document discusses two main types of skeletal muscle relaxants - neuromuscular blockers which relax normal muscles and are used primarily during anesthesia, and spasmolytics which reduce spasticity and are used to treat various neurologic conditions. It provides details on specific drugs in each category, their mechanisms of action, uses, effects, and adverse effects. Neuromuscular blockers can be further classified as competitive antagonists like tubocurarine or depolarizing agents like succinylcholine.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd

    L-19 Skeletal Muscle Relaxant

    Uploaded by

    Zakiyahulfahdw
    160 views26 pages
    The document discusses two main types of skeletal muscle relaxants - neuromuscular blockers which relax normal muscles and are used primarily during anesthesia, and spasmolytics which reduce spasticity and are used to treat various neurologic conditions. It provides details on specific drugs in each category, their mechanisms of action, uses, effects, and adverse effects. Neuromuscular blockers can be further classified as competitive antagonists like tubocurarine or depolarizing agents like succinylcholine.

    Original Description:

    Pelumpuh otot

    Original Title

    L-19 Skeletal Muscle Relaxant (1)

    Copyright

    © © All Rights Reserved

    Available Formats

    PPTX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    The document discusses two main types of skeletal muscle relaxants - neuromuscular blockers which relax normal muscles and are used primarily during anesthesia, and spasmolytics which reduce spasticity and are used to treat various neurologic conditions. It provides details on specific drugs in each category, their mechanisms of action, uses, effects, and adverse effects. Neuromuscular blockers can be further classified as competitive antagonists like tubocurarine or depolarizing agents like succinylcholine.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    160 views26 pages

    L-19 Skeletal Muscle Relaxant

    Uploaded by

    Zakiyahulfahdw
    The document discusses two main types of skeletal muscle relaxants - neuromuscular blockers which relax normal muscles and are used primarily during anesthesia, and spasmolytics which reduce spasticity and are used to treat various neurologic conditions. It provides details on specific drugs in each category, their mechanisms of action, uses, effects, and adverse effects. Neuromuscular blockers can be further classified as competitive antagonists like tubocurarine or depolarizing agents like succinylcholine.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 26

    Skeletal Muscle Relaxants

    Dr Naser Ashraf
    Types of skeletal muscle relaxants: 2 groups

    • Neuromuscular blockers • Spasmolytics

    • Relax normal muscles • Reduce spasticity


    (surgery and assistance • Centrally acting (except
    of ventilation) dantrolene which act on
    • No central nervous the skeletal muscle)
    system activity. • Used in a variety of
    • Used primarily as a part neurologic conditions
    of general anesthesia
    Skeletal Muscle Relaxants

    Neuromuscular
    Spasmolytics
    blockers
    Non-depolarizing
    (Competitive)
    • D tubocurarine
    Centrally Directly
    • Pancuronium
    acting acting
    • Vecuronium
    • Atracurium
    • Diazepam • Dantrolene
    • Mivacurium
    • Chlorzoxazone
    • Tizanidine
    • Baclofen
    Depolarizing
    (Non-Competitive)
    • Succinylcholine
    • Decamethomium
    Skeletal Muscle contraction
    Na+
    Na +

    Ca

    a
    2+

    a b
    ACH
    Ac
    tio
    nP
    ote
    nti
    al

    ACH ACH
    ACH ACH NMreceptor
    ACH

    a
    ACH

    b
    ACH
    ACH

    a
    ACH
    Motor neuron ACH
    ACH
    ACH
    a
    ba ACHEsterase

    Skeletal
    Muscle
    Mechanism of action of
    Neuromuscular Blockers
    Normal d-Tubocurarine Succinylcholine

    Ach A Ch Ach Ach SCh

    Ach SCh

    Depolarization No Depolarization Persistent Depolarization


    Contraction
    Repolarization (Fasciculation)

    Contraction No contraction Relaxation

    Relaxation Flaccid Paralysis


    Competitive Antagonists
    (Non-depolarizing Blockers)
    (Non-depolarizing blockers)

    • Long-acting: d tubocurarine,
    pancuronium

    • Intermediate: Atracurium , vecuronium ,

    rocuronium ,
    Anti-cholinestrases
    (neostigmine, Mechanism of Action
    edrophonium) Competitive Antagonism
    which preserve
    acetylcholine Agonist
    are used to reverse
    the effect of
    d-tubocurarine
    Ach Ach
    Antagonist
    d-Tubocurarine
    Affinity : Yes
    Intrinsic action : No

    NM receptor

    Motor End Plate


    Actions
    • Muscle weakness  Flaccid paralysis
    • Order of muscle affected:
    – Extrinsic eye muscles, muscles of finger
    – Neck muscles (muscles of phonation and swallowing)
    – Face
    – Hands,
    – Feet
    – Trunk
    – Respiratory muscles (intercostal and diaphragm)
    • Recovery in the reverse order
    • Consciousness, appreciation of pain not affected
    Actions
    • Autonomic ganglion blocking property
    • Histamine release (by d-tubocurarine)
    • CVS
    – Significant fall in BP
    – Increase in Heart rate
    – Vagal gangionic blockade (also ‘ve’ and ‘pan’)
    • Newer competitive blockers:
    – Negligible effect on BP and HR
    Adverse effects
    • Hypotension
    • Tachycardia
    • Respiratory paralysis
    • Bronchospasm
    • Aspiration of gastric contents
    Advantages of synthetic (Newer)
    competitive blockers
    • Less histamine release
    • Do not block autonomic ganglia
    • Spontaneous recovery with most of drugs
    • Rapacuronium & rocuronium have rapid onset
    • Atracuronium: Hoffmans elimination
    • Mivacurium short acting
    Uses
    • As an adjunct to general anaesthesia
    – For producing satisfactory skeletal muscle
    relaxation
    • For facilitating endotracheal intubation
    – Rocuronium preferred due to rapid onset of
    action
    – Succinylcholine is better due to short lasting
    duration
    Depolarizing Blocker
    (Non-competitive Antagonist)
    Succinylcholine
    One Drug, Two blocks,
    Brief and quick,
    Genetic variability in metabolism,
    Malignant hyperthermia
    Skeletal Muscle Relaxants

    Quaternary
    Succinyl Choline Quaternary
    Depolarising muscle relaxants
    ammonium ammonium

    Two molecules of Acetylcholine)

    Acetylcholine
    Mechanism of action

    Agonist at Nicotinic (NM) receptor


    Produces neuromuscular block by overstimulation, end plate is unable to
    respond to further stimulation.
    Longer lasting or persistent depolarization
    Succinylcholine

    Actions

    • Small rapidly moving muscles (eye, jaw, larynx)


    relax before those of limbs and trunks
    • Ultimately intercostals and finally diaphragm
    paralysis occur  respiratory paralysis
    • Recovery in the reverse order
    • Muscle relaxation: Onset: within 1 min; peak: 2
    min, duration: 5 min; longer duration relaxation
    requires continued IV infusion
    Succinylcholine
    Uses
    Suitable for short-term procedures
    • Rapid endotracheal intubation during induction of
    anaesthesia
    • During Electro-Convulsive shock Therapy (ECT)
    – To prevent injury
    Succinylcholine
    Adverse Effects
    • Transient Intraocular Tension
    • Hyperkalemia : Fasciculations release
    potassium in blood
    • Succinylcholine apnoea
    • Malignant hyperthermia: when used alng
    with halothane in general anaesthesia
    – Treatment is by rapid cooling of patient &
    dantrolene i.v
    • Muscle pain
    Treatment of succinylcholine
    apnoea
    • No antidote is available
    • Fresh frozen plasma should be infused
    • Patient should be ventilated artificially
    untill full recovery
    Comparison of Competitive and Depolarizing
    Blocking Agents
    Sr.no Competitive Succinyl choline
    1 Competitive blockade Persistant depolarization
    2 Non depolarizing Depolarizing
    3 Single block Dual block
    4 Anticholinesterases Do not reverse
    reverse blockade
    5 Initial fasciculations not Present
    present
    6 Slow onset long Rapid onset short
    duration duration
    7 Release histamine Doesn’t release
    Dantrolene
    • Directly acting skeletal Muscle relaxant
    • Inhibits depolarization induced calcium
    release from sarcoplasmic reticulum by
    acting on ryanodine receptors
    • Drug of choice in malignant hyperthermia
    Drug interactions
    • Non depolarizing blockers
    – Anticholine-esterases (Neostigmine)
    • Reverse the action of only non depolarizing
    blockers
    – Halothane, Aminoglycoside antibiotic like
    gentamicin & calcium channel blockers like
    nifedipine
    • Enhances the neuromuscular blockade
    • Depolarizing blockers
    – Halothane can cause malignant hyperthermia
    Ganglion blockers
    • Competitive blockers • Persistant depolarizing
    – Hexamethonium – Nicotine large dose
    – Trimethaphan
    – Mecamylamine
    Actions & Adverse effects of ganglion blockers
    S.No Organ Dominant ANS Effect/(side effect)of ganglionic
    blockade

    1. Heart Parasympathetic Tachycardia (Palpitations)


    2. Blood vessels Sympathetic Vasodilation (Hypotension)
    3. Iris Parasympathetic Mydriasis (Photophobia)
    4. Ciliary Muscle Parasympathetic Cycloplegia (Blurring of vision)
    5. Intestines Parasympathetic ↓ motility (Constipation)
    6. Bladder Parasympathetic ↓ tone (difficulty in micturation)
    7. Male sexual function Parasympathetic Inhibition of erection & ejaculation
    (Impotence)
    8. Salivary Glands Parasympathetic Inhibition of salivation (dry mouth,
    difficulty in swallowing)
    9. Sweat Glands Sympathetic Inhibition of sweating

    You might also like

    pFad - Phonifier reborn

    Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

    Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


    Alternative Proxies:

    Alternative Proxy

    pFad Proxy

    pFad v3 Proxy

    pFad v4 Proxy